The five-year-old ran into my exam room with his mother trailing behind. He wore a Transformers T-shirt and jeans that each bore signs of a recent encounter with a chocolate bar. Immediately he took a toy train apart and scattered the pieces all over the floor. “The kindergarten teacher said she doesn’t think Jason belongs in the class,” the mother said to me. “But we’re not sure.” Jason’s pediatrician had referred him to me because of his hyperactive behavior. “New patient to me,” her note said. “No old records available. Very hyperactive, difficult to examine, possible developmental delay: refer to developmental pediatrician.”
Having been a general pediatrician for many years before specializing in developmental pediatrics, I sympathized with her. The 20 minutes allotted for a standard exam wasn’t nearly enough to try to figure out what was going on with this child.
Jason was now busy with a ball, but then quickly moved to a book and began turning the pages and pointing to every picture, labeling each one: “House! Duck! Train!” Then he was off to crash two trucks together.
